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Is lamictal making me manic becuase the lithium isnt working?
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Is lamictal making me manic becuase the lithium isnt working?

I was in a deep depression  for a long time, When I went to the psych she put me on lamictal, when I went back to see her I asked how fast it got into the system because I thought I noticed a change from day one. After talking about my behavior, she said no, the lamictal takes 2-3 weeks at least to get in the system and she thought I was going manic. She then put me on lithium to stop the mania. After my first blood test .3 way to low she upped me to 900. What I am wondering is if the lithium is even working (she hasn't as of yet told me to have more bloodwork done), I honestly feel like the lamictal is making and keeping me manic. I love it but am scared of the repercussions it will have. Everytime (only twice :)) I wake up NOT in a good mood I'm thinking "Is this the day I'm gonna go to the dark side and pay the price for all this happiness (and yes irritability)?" I usually rapid cycle but I've been like this for about 4 weeks now (since I began the lamictal). And you know this is way better than being depressed. I'm not doing anything harmful to myself or others, I'm not overspending. I can tell you my house has NEVER been more clean and organized though. I get up everyday feeling excited. I love it! I have been more irritable and snappy. But not too bad. I'm just scared that I may be riding the fun train directly into a wall. Or is maybe the lamictal working great and I just never knew life without depression? I know I can discuss all of this with my doctor, but my appt is not until march 18. Should I call and tell her??
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585414_tn?1288944902
Yes you should speak to your psychiatrist. Right now its hard to tell because 900 mg. is a subclinical dose of lithium. I believe (ask your psychiatrist) it doesn't become effective until 1200 mg. and then it takes a while to build up a blood level. Its common to have mania emerge when changing from one mood stabilizer to another. However, if there is a concern that specifically as the Lamictal was raised things gradually got worse bring this to your psychiatrist's attention.  There are other options for mood stabilizers as well although perhaps less used (Trileptal, Neurontin, Topomax (topamax), Keppra, Lovaza, on occasion Clonidine as I take and others, you can read more on the websites on the links page). Speak to your psychiatrist about all of this.
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603015_tn?1329866573
I am almost in the same position as you, my mood flipped up when I went from 400mg to 1000mg of lithium, I am also on 1500mg of epilim. I am also wounderring wether I am hypomanic or is this normal and I just didnt realise how good you can feel normal, who knows, I am seeing my doc on wednesday and I have just had my bloods taken yesterday ready for the meeting. I would contact them and just let them know what has happened as your appointment is too far down the line in my opinion, when on 400mg my level was .4, as far as i know the theraputic level ranges from 750mg to 2000mg and this depends on the person as to what amount becomes theraputic because its measured per litre from my understanding.
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767237_tn?1332643777
Thank you for commenting! (hell) I have also heard that about the range. It is different for everyone since we make lithium in the brain naturally. From what I understand the therapeutic range is somewhere between .6 and .9. My level was .3 (so not even in the window) and I was only bumped up to 900 from 600. I really dont think that would be enough to even put me into that window of effectiveness. But you do think that the hyperactiveness could be from the lithium not being effective yet. Maybe I could call and have them send an order to check my blood. In a strange way though I like the lamictal. Oh geez I'm an idiot....know wonder I like it. Mania is fun! lol But really I dont want to change moodstabilizers. Do you think that if my lithium starts working I won't have to change?
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585414_tn?1288944902
Actually I remember changing from lithium to Lamictal is 1998. I was wildly manic and psychotic as well and did some destructive and self destructive stuff I'd rather not post here but it started off seeming like fun. I was on Seroquel then as well as an antipsychotic and had to raise it just to keep myself out of trouble. The problem may very well be the slow titration dose of raising Lamictal but that's FDA required for reasons discused. As regarding Lithium generally 1200 mg. is where it starts to be effective but you can speak to your psychiatrist about that. At a proper dose of Lamictal it worked very well. It wasn't until years later that it made me manic but by then it had stopped working. For a long while it worked well. Its hard to tell mania from medication induced mania while its happenning. Why not speak to your psychiatrist so they can tell better what is going on?
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731160_tn?1297275908
I am taking Lithium (1200mg) and Lamictal (200mg) and things have been good for the last month.  Last year I was all over the place just with the Lamictal and was on a roller coaster with extreme highs and lows.  My doc had me increase my Lithium from 600 to 1200 mg over 2 months.

So I guess my advice is to stick with plan to get your Lithium up to therapeutic levels, it will eventually level you out.  From what you describe it sounds like you are hypomanic as you getting stuff done and functioning its OK to be irritable once and awhile....we all do.

Take care and be kind to yourself!

T
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I should interject, that Lithium can be at therapeudic levels much lower, going up to 1500mgs is in the very high range of dosage.  When I first got pulled out of my depression @200mgs of Lamictal, I'd been so used to the depression, I wasn't sure what to do with myself. I had no clue what good felt like. When I was on Lith @900mgs, it didn't do anything for the hypo, but it did help when I had a short lived dip in October. I went off it in January after finding out I was borderline diabetic and it was affecting my kidneys, pretty rare for non-diabetics.

I had my Seroquel upped and moved to Extended release which has helped much more. I still get hypo but I'm not  having rages or super crankiness, which I had on lower doses. I don't think there is absolute "cure" to either ranges of moods. I sure as heck don't mind the hypo, if it keeps me from depression.  I have learned that I do get a short bout of depression if I'm not careful to control the hypo moments.

I'm on a fairly strict sleep schedule, I have stopped anything that has stimulants except one cup of coffee a day, I've even drastically cut down on my sugar and chocolate consumption - both of which can cause some hypomania. With all the meds, and diet and moderation, it's a lot to keep up with, sometimes it's just plain tiring to be so vigilant, but if I don't that sneaky mania creeps in, it happened last weekend and i ended up crashing for 2 days.

How much Lamictal are you on?  

You are right beat, Lith levels are different for each person, if you are trying to bring down the psychotic or manic behaviours sure 12-1500mgs may be required but not for folks with milder hypomania(usually), my pdoc said that if you are over 1500mgs/day you should be supervised in a hospital setting. You've checked your blood levels - and you'll figure out with your pdoc the exact amount. It's also important that you do your blood test exactly at 8 hours after taking it to have the most accurate level showing. Many docs don't realize that, I found that out from a lab tech, and they won't do one if it's been more then 10 hours since you took a dose. :)
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Avatar_f_tn
I hope you talk to your psychiatrist soon. I know where you're coming from, to an extent. For years, I was mostly depressed. Then I started getting a lot more hypomania but  soon went back down. Unfortunately, I now seem to go between depressed and mixed states. It's been a battle for months... I don't know if my lithium is working either. I'm only on 900mg, but I couldn't tolerate 1200mg; it only seemed to provide a small amount of relief anyway. Not worth the problems which are almost totally gone again at 900mg. I get the shakes pretty bad, but just when I'm wondering if it will ever stop it stops. I'm on Topamax also, but was on Lamictal twice before. Hopefully, the Lithium/Lamictal combination will work for you after they get the bugs worked out.

There are some generalizations that can be made about lithium levels, but those may or may not hold true for individuals. In my opinion we are coming dangerously close to giving medical advice if we tell someone what amount of lithium is most likely to be effective or safe. It might not be effective/safe for that person. It especially scares me to hear someone give a specific dosage level and imply it's safe. We don't know. If we knew, they wouldn't want to do blood tests. There's a dosage where they can *usually*, safely assume that a person can tolerate it - and it is still lower than the level suggested as effective. I've now had more than one medical professional name that number...Therapeutic levels also have a little more flexibility than I'd been told by some laymen, especially if there are a combination of mood stabilizers used. Therapeutic level only means where it might be expected to be effective. It doesn't mean that it will be effective. If you're dosing multiple times daily, you need to know when you had your last dose. Your doses may not be equal amounts and you may not maintain equal concentrations all day. It has to be taken into account, but it may not be as rigid as you think. Taking an extended release form of lithium once a day, I was specifically told the level in between was what was important. That was at the 12 hour mark.

Obviously, there are variations in what some of us have been told by various health care providers. It's very, very important to remember that you have to do what feels right for you. Sift through the info yourself and talk to your psychiatrist, lab people, and pharmacists, etc. There are some strong opinions out there and they don't all agree. It doesn't take a lot to put doubt in my mind, so I hope you'll trust yourself and not think anything people, including me, have said is written in stone. I questioned a lot of what I was doing because of a few poorly worded comments or suggestions and that was a waste when I was already a train wreck. Take care.  
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767237_tn?1332643777
I KNOW EXACTLY WHAT YOU MEAN!!!!!!!!!!!!!!!!!!!!!!!!!!!!! AMEN AND WELL SAID!!!!!!!! I know everyone is only trying to help but like you said there are a lot of strong, harsh and set in stone answers and I really would feel bad for someone completely new to all this. I know the first few times I got on here I really started to take some of the things people said to heart, personally and like they were actual jabs at me. I don't think some people realize that there are a lot of unstable people on here and we can get our feeling hurt easily and drive ourselves crazy, second guessing our docs and even ourselves. I just think we should be supportive and stop throwing out those "It's this level/mg or it doesn't work" statements. Ive had plenty of those thrown at me and the funny thing is that I've never asked a question wanting someone to tell me what my dosage should be. Only my blood levels and pdoc can tell me that! So thank you for your comment, it definitely needed to be said. Thank you 2009toads for your comment as well and thank you to the rest who commented, it's always very much appreciated. One question to all- how can you tell the difference between hypomania and just not being depressed?? It's been so long since the ups and downs and I'v beeen so happy I just cant tell anymore. Should I be expecting that big downfall form all these weeks of excitement?? Toads- maybe you could message me so we could talk a little more about it, you were saying you could relate..
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